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Powles T, Tomczak P, Park SH, Venugopal B, Ferguson T, Symeonides SN, Hajek J, Gurney H, Chang YH, Lee JL, Sarwar N, Thiery-Vuillemin A, Gross-Goupil M, Mahave M, Haas NB, Sawrycki P, Burgents JE, Xu L, Imai K, Quinn DI, Choueiri TK, Choueiri T, Park SH, Venugopal B, Ferguson TR, Hajek J, Lin TP, Symeonides SN, Lee JL, Sawrycki P, Haas NB, Gurney HP, Mahave M, Sarwar N, Thiery-Vuillemin A, Gross-Goupil M, Chevreau C, Burke JM, Doshi G, Melichar B, Topart D, Oudard S, Kopyltsov E, Hammers HJ, Quinn DI, Alva A, Menezes JDJ, Silva AGE, Winquist EW, Hamzaj A, Procopio G, Karaszewska B, Nowakowska-Zajdel EM, Alekseev BY, Gafanov RA, Izmailov A, Semenov A, Afanasyev SG, Lipatov ON, Powles TB, Srinivas S, McDermott D, Kochuparambil ST, Davis ID, Peltola K, Sabbatini R, Chung J, Shkolnik MI, Matveev VB, Gajate Borau P, McCune S, Hutson TE, Dri A, Sales SC, Yeung C, Alcala Castro CM, Bostrom P, Laguerre B, Buttigliero C, de Giorgi U, Fomin EA, Zakharia Y, Hwang C, Singer EA, Yorio JT, Waterhouse D, Kowalyszyn RD, Alfie MS, Yanez Ruiz E, Buchler T, Kankaanranta K, Ferretti G, Kimura G, Nishimura K, Masumori N, Tamada S, Kato H, Kitamura H, Danielewicz I, Wojcik-Tomaszewska J, Sala Gonzalez N, Chiu KY, Atkins MB, Heath E, Rojas-Uribe GA, Gonzalez Fernandez ME, Feyerabend S, Pignata S, Numakura K, Cybulska Stopa B, Zukov R, Climent Duran MA, Maroto Rey PJ, Montesa Pino A, Chang CH, Vengalil S, Waddell TS, Cobb PW, Hauke R, Anderson DM, Sarantopoulos J, Gourdin T, Zhang T, Jayram G, Fein LE, Harris C, Beato PMM, Flores F, Estay A, Rubiano JA, Bedke J, Hauser S, Neisius A, Busch J, Anai S, Tsunemori H, Sawka D, Sikora-Kupis B, Arranz JA, Delgado I, Chen CH, Gunderson E, Tykodi S, Koletsky A, Chen K, Agrawal M, Kaen DL, Sade JP, Tatangelo MD, Parnis F, Barbosa FM, Faucher G, Iqbal N, Marceau D, Paradis JB, Hanna N, Acevedo A, Ibanez C, Villanueva L, Galaz PP, Durango IC, Manneh R, Kral Z, Holeckova P, Hakkarainen H, Ronkainen H, Abadie-Lacourtoisie S, Tartas S, Goebell PJ, Grimm MO, Hoefner T, Wirth M, Panic A, Schultze-Seemann W, Yokomizo A, Mizuno R, Uemura H, Eto M, Tsujihata M, Matsukawa Y, Murakami Y, Kim M, Hamberg P, Marczewska-Skrodzka M, Szczylik C, Humphreys AC, Jiang P, Kumar B, Lu G, Desai A, Karam JA, Keogh G, Fleming M, Zarba JJ, Leiva VE, Mendez GA, Harris SJ, Brown SJ, Antonio Junior JN, Costamilan RDC, Rocha RO, Muniz D, Brust L, Lalani AK, Graham J, Levesque M, Orlandi F, Kotasek R, Deville JL, Borchiellini D, Merseburger A, Rink M, Roos F, McDermott R, Oyama M, Yamamoto Y, Tomita Y, Miura Y, Ioritani N, Westgeest H, Kubiatowski T, Bal W, Girones Sarrio R, Rowe J, Prow DM, Senecal F, Hashemi-Sadraei N, Cole SW, Kendall SD, Richards DA, Schnadig ID, Gupta M. Pembrolizumab versus placebo as post-nephrectomy adjuvant therapy for clear cell renal cell carcinoma (KEYNOTE-564): 30-month follow-up analysis of a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol 2022; 23:1133-1144. [PMID: 36055304 DOI: 10.1016/s1470-2045(22)00487-9] [Citation(s) in RCA: 110] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND The first interim analysis of the KEYNOTE-564 study showed improved disease-free survival with adjuvant pembrolizumab compared with placebo after surgery in patients with clear cell renal cell carcinoma at an increased risk of recurrence. The analysis reported here, with an additional 6 months of follow-up, was designed to assess longer-term efficacy and safety of pembrolizumab versus placebo, as well as additional secondary and exploratory endpoints. METHODS In the multicentre, randomised, double-blind, placebo-controlled, phase 3 KEYNOTE-564 trial, adults aged 18 years or older with clear cell renal cell carcinoma with an increased risk of recurrence were enrolled at 213 hospitals and cancer centres in North America, South America, Europe, Asia, and Australia. Eligible participants had an Eastern Cooperative Oncology Group performance status of 0 or 1, had undergone nephrectomy 12 weeks or less before randomisation, and had not received previous systemic therapy for advanced renal cell carcinoma. Participants were randomly assigned (1:1) via central permuted block randomisation (block size of four) to receive pembrolizumab 200 mg or placebo intravenously every 3 weeks for up to 17 cycles. Randomisation was stratified by metastatic disease status (M0 vs M1), and the M0 group was further stratified by ECOG performance status and geographical region. All participants and investigators involved in study treatment administration were masked to the treatment group assignment. The primary endpoint was disease-free survival by investigator assessment in the intention-to-treat population (all participants randomly assigned to a treatment). Safety was assessed in the safety population, comprising all participants who received at least one dose of pembrolizumab or placebo. As the primary endpoint was met at the first interim analysis, updated data are reported without p values. This study is ongoing, but no longer recruiting, and is registered with ClinicalTrials.gov, NCT03142334. FINDINGS Between June 30, 2017, and Sept 20, 2019, 994 participants were assigned to receive pembrolizumab (n=496) or placebo (n=498). Median follow-up, defined as the time from randomisation to data cutoff (June 14, 2021), was 30·1 months (IQR 25·7-36·7). Disease-free survival was better with pembrolizumab compared with placebo (HR 0·63 [95% CI 0·50-0·80]). Median disease-free survival was not reached in either group. The most common all-cause grade 3-4 adverse events were hypertension (in 14 [3%] of 496 participants) and increased alanine aminotransferase (in 11 [2%]) in the pembrolizumab group, and hypertension (in 13 [3%] of 498 participants) in the placebo group. Serious adverse events attributed to study treatment occurred in 59 (12%) participants in the pembrolizumab group and one (<1%) participant in the placebo group. No deaths were attributed to pembrolizumab. INTERPRETATION Updated results from KEYNOTE-564 support the use of adjuvant pembrolizumab monotherapy as a standard of care for participants with renal cell carcinoma with an increased risk of recurrence after nephrectomy. FUNDING Merck Sharp & Dohme LLC, a subsidiary of Merck & Co, Inc, Rahway, NJ, USA.
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Affiliation(s)
- Thomas Powles
- Royal Free Hospital NHS Foundation Trust, University College London, London, UK; Barts Cancer Institute, Experimental Cancer Medicine Centre, Queen Mary University of London, St Bartholomew's Hospital, London, UK.
| | - Piotr Tomczak
- Poznań University of Medical Sciences, Poznań, Poland
| | - Se Hoon Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Balaji Venugopal
- Beatson West of Scotland Cancer Centre, Glasgow, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | - Stefan N Symeonides
- Cancer Research UK Edinburgh Centre, Edinburgh, UK; Edinburgh Cancer Centre, Edinburgh, UK; Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | | | - Howard Gurney
- Department of Clinical Medicine, Macquarie University, Sydney, NSW, Australia
| | | | - Jae Lyun Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | | | | | | | | | - Piotr Sawrycki
- Wojewódzki Szpital Zespolony im L Rydygiera w Toruniu, Torun, Poland
| | | | - Lei Xu
- Merck & Co, Inc, Rahway, NJ, USA
| | | | - David I Quinn
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
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Mullane KM, Morrison VA, Camacho LH, Arvin A, McNeil SA, Durrand J, Campbell B, Su SC, Chan ISF, Parrino J, Kaplan SS, Popmihajlov Z, Annunziato PW, Cerana S, Dictar MO, Bonvehi P, Tregnaghi JP, Fein L, Ashley D, Singh M, Hayes T, Playford G, Morrissey O, Thaler J, Kuehr T, Greil R, Pecherstorfer M, Duck L, Van Eygen K, Aoun M, De Prijck B, Franke FA, Barrios CHE, Mendes AVA, Serrano SV, Garcia RF, Moore F, Camargo JFC, Pires LA, Alves RS, Radinov A, Oreshkov K, Minchev V, Hubenova AI, Koynova T, Ivanov I, Rabotilova B, Minchev V, Petrov PA, Chilingirov P, Karanikolov S, Raynov J, Grimard D, McNeil S, Kumar D, Larratt LM, Weiss K, Delage R, Diaz-Mitoma FJ, Cano PO, Couture F, Carvajal P, Yepes A, Torres Ulloa R, Fardella P, Caglevic C, Rojas C, Orellana E, Gonzalez P, Acevedo A, Galvez KM, Gonzalez ME, Franco S, Restrepo JG, Rojas CA, Bonilla C, Florez LE, Ospina AV, Manneh R, Zorica R, Vrdoljak DV, Samarzija M, Petruzelka L, Vydra J, Mayer J, Cibula D, Prausova J, Paulson G, Ontaneda M, Palk K, Vahlberg A, Rooneem R, Galtier F, Postil D, Lucht F, Laine F, Launay O, Laurichesse H, Duval X, Cornely OA, Camerer B, Panse J, Zaiss M, Derigs HG, Menzel H, Verbeek M, Georgoulias V, Mavroudis D, Anagnostopoulos A, Terpos E, Cortes D, Umanzor J, Bejarano S, Galeano RW, Wong RSM, Hui P, Pedrazzoli P, Ruggeri L, Aversa F, Bosi A, Gentile G, Rambaldi A, Contu A, Marei L, Abbadi A, Hayajneh W, Kattan J, Farhat F, Chahine G, Rutkauskiene J, Marfil Rivera LJ, Lopez Chuken YA, Franco Villarreal H, Lopez Hernandez J, Blacklock H, Lopez RI, Alvarez R, Gomez AM, Quintana TS, Moreno Larrea MDC, Zorrilla SJ, Alarcon E, Samanez FCA, Caguioa PB, Tiangco BJ, Mora EM, Betancourt-Garcia RD, Hallman-Navarro D, Feliciano-Lopez LJ, Velez-Cortes HA, Cabanillas F, Ganea DE, Ciuleanu TE, Ghizdavescu DG, Miron L, Cebotaru CL, Cainap CI, Anghel R, Dvorkin MV, Gladkov OA, Fadeeva NV, Kuzmin AA, Lipatov ON, Zbarskaya II, Akhmetzyanov FS, Litvinov IV, Afanasyev BV, Cherenkova M, Lioznov D, Lisukov IA, Smirnova YA, Kolomietz S, Halawani H, Goh YT, Drgona L, Chudej J, Matejkova M, Reckova M, Rapoport BL, Szpak WM, Malan DR, Jonas N, Jung CW, Lee DG, Yoon SS, Lopez Jimenez J, Duran Martinez I, Rodriguez Moreno JF, Solano Vercet C, de la Camara R, Batlle Massana M, Yeh SP, Chen CY, Chou HH, Tsai CM, Chiu CH, Siritanaratkul N, Norasetthada L, Sriuranpong V, Seetalarom K, Akan H, Dane F, Ozcan MA, Ozsan GH, Kalayoglu Besisik SF, Cagatay A, Yalcin S, Peniket A, Mullan SR, Dakhil KM, Sivarajan K, Suh JJG, Sehgal A, Marquez F, Gomez EG, Mullane MR, Skinner WL, Behrens RJ, Trevarthe DR, Mazurczak MA, Lambiase EA, Vidal CA, Anac SY, Rodrigues GA, Baltz B, Boccia R, Wertheim MS, Holladay CS, Zenk D, Fusselman W, Wade III JL, Jaslowsk AJ, Keegan J, Robinson MO, Go RS, Farnen J, Amin B, Jurgens D, Risi GF, Beatty PG, Naqvi T, Parshad S, Hansen VL, Ahmed M, Steen PD, Badarinath S, Dekker A, Scouros MA, Young DE, Graydon Harker W, Kendall SD, Citron ML, Chedid S, Posada JG, Gupta MK, Rafiyath S, Buechler-Price J, Sreenivasappa S, Chay CH, Burke JM, Young SE, Mahmood A, Kugler JW, Gerstner G, Fuloria J, Belman ND, Geller R, Nieva J, Whittenberger BP, Wong BMY, Cescon TP, Abesada-Terk G, Guarino MJ, Zweibach A, Ibrahim EN, Takahashi G, Garrison MA, Mowat RB, Choi BS, Oliff IA, Singh J, Guter KA, Ayrons K, Rowland KM, Noga SJ, Rao SB, Columbie A, Nualart MT, Cecchi GR, Campos LT, Mohebtash M, Flores MR, Rothstein-Rubin R, O'Connor BM, Soori G, Knapp M, Miranda FG, Goodgame BW, Kassem M, Belani R, Sharma S, Ortiz T, Sonneborn HL, Markowitz AB, Wilbur D, Meiri E, Koo VS, Jhangiani HS, Wong L, Sanani S, Lawrence SJ, Jones CM, Murray C, Papageorgiou C, Gurtler JS, Ascensao JL, Seetalarom K, Venigalla ML, D'Andrea M, De Las Casas C, Haile DJ, Qazi FU, Santander JL, Thomas MR, Rao VP, Craig M, Garg RJ, Robles R, Lyons RM, Stegemoller RK, Goel S, Garg S, Lowry P, Lynch C, Lash B, Repka T, Baker J, Goueli BS, Campbell TC, Van Echo DA, Lee YJ, Reyes EA, Senecal FM, Donnelly G, Byeff P, Weiss R, Reid T, Roeland E, Goel A, Prow DM, Brandt DS, Kaplan HG, Payne JE, Boeckh MG, Rosen PJ, Mena RR, Khan R, Betts RF, Sharp SA, Morrison VA, Fitz-Patrick D, Congdon J, Erickson N, Abbasi R, Henderson S, Mehdi A, Wos EJ, Rehmus E, Beltzer L, Tamayo RA, Mahmood T, Reboli AC, Moore A, Brown JM, Cruz J, Quick DP, Potz JL, Kotz KW, Hutchins M, Chowhan NM, Devabhaktuni YD, Braly P, Berenguer RA, Shambaugh SC, O'Rourke TJ, Conkright WA, Winkler CF, Addo FEK, Duic JP, High KP, Kutner ME, Collins R, Carrizosa DR, Perry DJ, Kailath E, Rosen N, Sotolongo R, Shoham S, Chen T. Safety and efficacy of inactivated varicella zoster virus vaccine in immunocompromised patients with malignancies: a two-arm, randomised, double-blind, phase 3 trial. The Lancet Infectious Diseases 2019; 19:1001-1012. [DOI: 10.1016/s1473-3099(19)30310-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 12/25/2022]
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Henry NL, Unger JM, Schott AF, Fehrenbacher L, Flynn PJ, Prow DM, Sharer CW, Burton GV, Kuzma CS, Moseley A, Lew DL, Fisch MJ, Moinpour CM, Hershman DL, Wade JL. Randomized, Multicenter, Placebo-Controlled Clinical Trial of Duloxetine Versus Placebo for Aromatase Inhibitor-Associated Arthralgias in Early-Stage Breast Cancer: SWOG S1202. J Clin Oncol 2017; 36:326-332. [PMID: 29136387 DOI: 10.1200/jco.2017.74.6651] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose Adherence to aromatase inhibitor (AI) therapy for early-stage breast cancer is limited by AI-associated musculoskeletal symptoms (AIMSS). Duloxetine is US Food and Drug Administration approved for treatment of multiple chronic pain disorders. We hypothesized that treatment of AIMSS with duloxetine would improve average joint pain compared with placebo. Methods This randomized, double-blind, phase III trial included AI-treated postmenopausal women with early-stage breast cancer and who had average joint pain score of ≥ 4 out of 10 that developed or worsened since AI therapy initiation. Patients were randomly assigned 1:1 to duloxetine or placebo for 13 weeks. The primary end point was average joint pain through 12 weeks, examined using multivariable linear mixed models, adjusted for stratification factors (baseline pain score of 4 to 6 v 7 to 10 and prior taxane use). Clinically significant change in average pain was defined as a ≥ 2-point decrease from baseline. Results Of 299 enrolled patients, 127 patients treated with duloxetine and 128 who received placebo were evaluable for the primary analysis. By 12 weeks, the average joint pain score was 0.82 points lower for patients who received duloxetine compared with those who received placebo (95% CI, -1.24 to -0.40; P = .0002). Similar patterns were observed for worst joint pain, joint stiffness, pain interference, and functioning. Rates of adverse events of any grade were higher in the duloxetine-treated group (78% v 50%); rates of grade 3 adverse events were similar. Conclusion Results of treatment with duloxetine for AIMSS were superior to those of placebo among women with early-stage breast cancer, although it resulted in more frequent low-grade toxicities.
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Affiliation(s)
- N Lynn Henry
- N. Lynn Henry and Anne F. Schott, University of Michigan, Ann Arbor, MI; N. Lynn Henry, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Joseph M. Unger, Anna Moseley, and Danika L. Lew, Southwest Oncology Group Statistical Center and Fred Hutchinson Cancer Research Center; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; Louis Fehrenbacher, Kaiser Permanente National Cancer Institute Community Oncology Research Program, Oakland, CA; Patrick J. Flynn, Metro Minnesota Community Clinical Oncology Program/Minnesota Oncology, St Louis Park, MN; Debra M. Prow, William R. Bliss Cancer Center, Ames, IA; Carl W. Sharer, Phoenixville Cancer Center, Phoenixville, PA; Gary V. Burton, Louisiana State University Health Science Center-Shreveport, Shreveport, LA; Charles S. Kuzma, FirstHealth of the Carolinas, Pinehurst, NC; Michael J. Fisch, AIM Specialty Health, Chicago, IL; Dawn L. Hershman, Columbia University, New York, NY; and James L. Wade III, Heartland National Cancer Institute Community Oncology Research Program, Decatur, IL
| | - Joseph M Unger
- N. Lynn Henry and Anne F. Schott, University of Michigan, Ann Arbor, MI; N. Lynn Henry, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Joseph M. Unger, Anna Moseley, and Danika L. Lew, Southwest Oncology Group Statistical Center and Fred Hutchinson Cancer Research Center; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; Louis Fehrenbacher, Kaiser Permanente National Cancer Institute Community Oncology Research Program, Oakland, CA; Patrick J. Flynn, Metro Minnesota Community Clinical Oncology Program/Minnesota Oncology, St Louis Park, MN; Debra M. Prow, William R. Bliss Cancer Center, Ames, IA; Carl W. Sharer, Phoenixville Cancer Center, Phoenixville, PA; Gary V. Burton, Louisiana State University Health Science Center-Shreveport, Shreveport, LA; Charles S. Kuzma, FirstHealth of the Carolinas, Pinehurst, NC; Michael J. Fisch, AIM Specialty Health, Chicago, IL; Dawn L. Hershman, Columbia University, New York, NY; and James L. Wade III, Heartland National Cancer Institute Community Oncology Research Program, Decatur, IL
| | - Anne F Schott
- N. Lynn Henry and Anne F. Schott, University of Michigan, Ann Arbor, MI; N. Lynn Henry, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Joseph M. Unger, Anna Moseley, and Danika L. Lew, Southwest Oncology Group Statistical Center and Fred Hutchinson Cancer Research Center; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; Louis Fehrenbacher, Kaiser Permanente National Cancer Institute Community Oncology Research Program, Oakland, CA; Patrick J. Flynn, Metro Minnesota Community Clinical Oncology Program/Minnesota Oncology, St Louis Park, MN; Debra M. Prow, William R. Bliss Cancer Center, Ames, IA; Carl W. Sharer, Phoenixville Cancer Center, Phoenixville, PA; Gary V. Burton, Louisiana State University Health Science Center-Shreveport, Shreveport, LA; Charles S. Kuzma, FirstHealth of the Carolinas, Pinehurst, NC; Michael J. Fisch, AIM Specialty Health, Chicago, IL; Dawn L. Hershman, Columbia University, New York, NY; and James L. Wade III, Heartland National Cancer Institute Community Oncology Research Program, Decatur, IL
| | - Louis Fehrenbacher
- N. Lynn Henry and Anne F. Schott, University of Michigan, Ann Arbor, MI; N. Lynn Henry, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Joseph M. Unger, Anna Moseley, and Danika L. Lew, Southwest Oncology Group Statistical Center and Fred Hutchinson Cancer Research Center; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; Louis Fehrenbacher, Kaiser Permanente National Cancer Institute Community Oncology Research Program, Oakland, CA; Patrick J. Flynn, Metro Minnesota Community Clinical Oncology Program/Minnesota Oncology, St Louis Park, MN; Debra M. Prow, William R. Bliss Cancer Center, Ames, IA; Carl W. Sharer, Phoenixville Cancer Center, Phoenixville, PA; Gary V. Burton, Louisiana State University Health Science Center-Shreveport, Shreveport, LA; Charles S. Kuzma, FirstHealth of the Carolinas, Pinehurst, NC; Michael J. Fisch, AIM Specialty Health, Chicago, IL; Dawn L. Hershman, Columbia University, New York, NY; and James L. Wade III, Heartland National Cancer Institute Community Oncology Research Program, Decatur, IL
| | - Patrick J Flynn
- N. Lynn Henry and Anne F. Schott, University of Michigan, Ann Arbor, MI; N. Lynn Henry, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Joseph M. Unger, Anna Moseley, and Danika L. Lew, Southwest Oncology Group Statistical Center and Fred Hutchinson Cancer Research Center; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; Louis Fehrenbacher, Kaiser Permanente National Cancer Institute Community Oncology Research Program, Oakland, CA; Patrick J. Flynn, Metro Minnesota Community Clinical Oncology Program/Minnesota Oncology, St Louis Park, MN; Debra M. Prow, William R. Bliss Cancer Center, Ames, IA; Carl W. Sharer, Phoenixville Cancer Center, Phoenixville, PA; Gary V. Burton, Louisiana State University Health Science Center-Shreveport, Shreveport, LA; Charles S. Kuzma, FirstHealth of the Carolinas, Pinehurst, NC; Michael J. Fisch, AIM Specialty Health, Chicago, IL; Dawn L. Hershman, Columbia University, New York, NY; and James L. Wade III, Heartland National Cancer Institute Community Oncology Research Program, Decatur, IL
| | - Debra M Prow
- N. Lynn Henry and Anne F. Schott, University of Michigan, Ann Arbor, MI; N. Lynn Henry, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Joseph M. Unger, Anna Moseley, and Danika L. Lew, Southwest Oncology Group Statistical Center and Fred Hutchinson Cancer Research Center; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; Louis Fehrenbacher, Kaiser Permanente National Cancer Institute Community Oncology Research Program, Oakland, CA; Patrick J. Flynn, Metro Minnesota Community Clinical Oncology Program/Minnesota Oncology, St Louis Park, MN; Debra M. Prow, William R. Bliss Cancer Center, Ames, IA; Carl W. Sharer, Phoenixville Cancer Center, Phoenixville, PA; Gary V. Burton, Louisiana State University Health Science Center-Shreveport, Shreveport, LA; Charles S. Kuzma, FirstHealth of the Carolinas, Pinehurst, NC; Michael J. Fisch, AIM Specialty Health, Chicago, IL; Dawn L. Hershman, Columbia University, New York, NY; and James L. Wade III, Heartland National Cancer Institute Community Oncology Research Program, Decatur, IL
| | - Carl W Sharer
- N. Lynn Henry and Anne F. Schott, University of Michigan, Ann Arbor, MI; N. Lynn Henry, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Joseph M. Unger, Anna Moseley, and Danika L. Lew, Southwest Oncology Group Statistical Center and Fred Hutchinson Cancer Research Center; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; Louis Fehrenbacher, Kaiser Permanente National Cancer Institute Community Oncology Research Program, Oakland, CA; Patrick J. Flynn, Metro Minnesota Community Clinical Oncology Program/Minnesota Oncology, St Louis Park, MN; Debra M. Prow, William R. Bliss Cancer Center, Ames, IA; Carl W. Sharer, Phoenixville Cancer Center, Phoenixville, PA; Gary V. Burton, Louisiana State University Health Science Center-Shreveport, Shreveport, LA; Charles S. Kuzma, FirstHealth of the Carolinas, Pinehurst, NC; Michael J. Fisch, AIM Specialty Health, Chicago, IL; Dawn L. Hershman, Columbia University, New York, NY; and James L. Wade III, Heartland National Cancer Institute Community Oncology Research Program, Decatur, IL
| | - Gary V Burton
- N. Lynn Henry and Anne F. Schott, University of Michigan, Ann Arbor, MI; N. Lynn Henry, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Joseph M. Unger, Anna Moseley, and Danika L. Lew, Southwest Oncology Group Statistical Center and Fred Hutchinson Cancer Research Center; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; Louis Fehrenbacher, Kaiser Permanente National Cancer Institute Community Oncology Research Program, Oakland, CA; Patrick J. Flynn, Metro Minnesota Community Clinical Oncology Program/Minnesota Oncology, St Louis Park, MN; Debra M. Prow, William R. Bliss Cancer Center, Ames, IA; Carl W. Sharer, Phoenixville Cancer Center, Phoenixville, PA; Gary V. Burton, Louisiana State University Health Science Center-Shreveport, Shreveport, LA; Charles S. Kuzma, FirstHealth of the Carolinas, Pinehurst, NC; Michael J. Fisch, AIM Specialty Health, Chicago, IL; Dawn L. Hershman, Columbia University, New York, NY; and James L. Wade III, Heartland National Cancer Institute Community Oncology Research Program, Decatur, IL
| | - Charles S Kuzma
- N. Lynn Henry and Anne F. Schott, University of Michigan, Ann Arbor, MI; N. Lynn Henry, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Joseph M. Unger, Anna Moseley, and Danika L. Lew, Southwest Oncology Group Statistical Center and Fred Hutchinson Cancer Research Center; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; Louis Fehrenbacher, Kaiser Permanente National Cancer Institute Community Oncology Research Program, Oakland, CA; Patrick J. Flynn, Metro Minnesota Community Clinical Oncology Program/Minnesota Oncology, St Louis Park, MN; Debra M. Prow, William R. Bliss Cancer Center, Ames, IA; Carl W. Sharer, Phoenixville Cancer Center, Phoenixville, PA; Gary V. Burton, Louisiana State University Health Science Center-Shreveport, Shreveport, LA; Charles S. Kuzma, FirstHealth of the Carolinas, Pinehurst, NC; Michael J. Fisch, AIM Specialty Health, Chicago, IL; Dawn L. Hershman, Columbia University, New York, NY; and James L. Wade III, Heartland National Cancer Institute Community Oncology Research Program, Decatur, IL
| | - Anna Moseley
- N. Lynn Henry and Anne F. Schott, University of Michigan, Ann Arbor, MI; N. Lynn Henry, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Joseph M. Unger, Anna Moseley, and Danika L. Lew, Southwest Oncology Group Statistical Center and Fred Hutchinson Cancer Research Center; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; Louis Fehrenbacher, Kaiser Permanente National Cancer Institute Community Oncology Research Program, Oakland, CA; Patrick J. Flynn, Metro Minnesota Community Clinical Oncology Program/Minnesota Oncology, St Louis Park, MN; Debra M. Prow, William R. Bliss Cancer Center, Ames, IA; Carl W. Sharer, Phoenixville Cancer Center, Phoenixville, PA; Gary V. Burton, Louisiana State University Health Science Center-Shreveport, Shreveport, LA; Charles S. Kuzma, FirstHealth of the Carolinas, Pinehurst, NC; Michael J. Fisch, AIM Specialty Health, Chicago, IL; Dawn L. Hershman, Columbia University, New York, NY; and James L. Wade III, Heartland National Cancer Institute Community Oncology Research Program, Decatur, IL
| | - Danika L Lew
- N. Lynn Henry and Anne F. Schott, University of Michigan, Ann Arbor, MI; N. Lynn Henry, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Joseph M. Unger, Anna Moseley, and Danika L. Lew, Southwest Oncology Group Statistical Center and Fred Hutchinson Cancer Research Center; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; Louis Fehrenbacher, Kaiser Permanente National Cancer Institute Community Oncology Research Program, Oakland, CA; Patrick J. Flynn, Metro Minnesota Community Clinical Oncology Program/Minnesota Oncology, St Louis Park, MN; Debra M. Prow, William R. Bliss Cancer Center, Ames, IA; Carl W. Sharer, Phoenixville Cancer Center, Phoenixville, PA; Gary V. Burton, Louisiana State University Health Science Center-Shreveport, Shreveport, LA; Charles S. Kuzma, FirstHealth of the Carolinas, Pinehurst, NC; Michael J. Fisch, AIM Specialty Health, Chicago, IL; Dawn L. Hershman, Columbia University, New York, NY; and James L. Wade III, Heartland National Cancer Institute Community Oncology Research Program, Decatur, IL
| | - Michael J Fisch
- N. Lynn Henry and Anne F. Schott, University of Michigan, Ann Arbor, MI; N. Lynn Henry, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Joseph M. Unger, Anna Moseley, and Danika L. Lew, Southwest Oncology Group Statistical Center and Fred Hutchinson Cancer Research Center; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; Louis Fehrenbacher, Kaiser Permanente National Cancer Institute Community Oncology Research Program, Oakland, CA; Patrick J. Flynn, Metro Minnesota Community Clinical Oncology Program/Minnesota Oncology, St Louis Park, MN; Debra M. Prow, William R. Bliss Cancer Center, Ames, IA; Carl W. Sharer, Phoenixville Cancer Center, Phoenixville, PA; Gary V. Burton, Louisiana State University Health Science Center-Shreveport, Shreveport, LA; Charles S. Kuzma, FirstHealth of the Carolinas, Pinehurst, NC; Michael J. Fisch, AIM Specialty Health, Chicago, IL; Dawn L. Hershman, Columbia University, New York, NY; and James L. Wade III, Heartland National Cancer Institute Community Oncology Research Program, Decatur, IL
| | - Carol M Moinpour
- N. Lynn Henry and Anne F. Schott, University of Michigan, Ann Arbor, MI; N. Lynn Henry, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Joseph M. Unger, Anna Moseley, and Danika L. Lew, Southwest Oncology Group Statistical Center and Fred Hutchinson Cancer Research Center; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; Louis Fehrenbacher, Kaiser Permanente National Cancer Institute Community Oncology Research Program, Oakland, CA; Patrick J. Flynn, Metro Minnesota Community Clinical Oncology Program/Minnesota Oncology, St Louis Park, MN; Debra M. Prow, William R. Bliss Cancer Center, Ames, IA; Carl W. Sharer, Phoenixville Cancer Center, Phoenixville, PA; Gary V. Burton, Louisiana State University Health Science Center-Shreveport, Shreveport, LA; Charles S. Kuzma, FirstHealth of the Carolinas, Pinehurst, NC; Michael J. Fisch, AIM Specialty Health, Chicago, IL; Dawn L. Hershman, Columbia University, New York, NY; and James L. Wade III, Heartland National Cancer Institute Community Oncology Research Program, Decatur, IL
| | - Dawn L Hershman
- N. Lynn Henry and Anne F. Schott, University of Michigan, Ann Arbor, MI; N. Lynn Henry, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Joseph M. Unger, Anna Moseley, and Danika L. Lew, Southwest Oncology Group Statistical Center and Fred Hutchinson Cancer Research Center; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; Louis Fehrenbacher, Kaiser Permanente National Cancer Institute Community Oncology Research Program, Oakland, CA; Patrick J. Flynn, Metro Minnesota Community Clinical Oncology Program/Minnesota Oncology, St Louis Park, MN; Debra M. Prow, William R. Bliss Cancer Center, Ames, IA; Carl W. Sharer, Phoenixville Cancer Center, Phoenixville, PA; Gary V. Burton, Louisiana State University Health Science Center-Shreveport, Shreveport, LA; Charles S. Kuzma, FirstHealth of the Carolinas, Pinehurst, NC; Michael J. Fisch, AIM Specialty Health, Chicago, IL; Dawn L. Hershman, Columbia University, New York, NY; and James L. Wade III, Heartland National Cancer Institute Community Oncology Research Program, Decatur, IL
| | - James L Wade
- N. Lynn Henry and Anne F. Schott, University of Michigan, Ann Arbor, MI; N. Lynn Henry, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Joseph M. Unger, Anna Moseley, and Danika L. Lew, Southwest Oncology Group Statistical Center and Fred Hutchinson Cancer Research Center; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; Louis Fehrenbacher, Kaiser Permanente National Cancer Institute Community Oncology Research Program, Oakland, CA; Patrick J. Flynn, Metro Minnesota Community Clinical Oncology Program/Minnesota Oncology, St Louis Park, MN; Debra M. Prow, William R. Bliss Cancer Center, Ames, IA; Carl W. Sharer, Phoenixville Cancer Center, Phoenixville, PA; Gary V. Burton, Louisiana State University Health Science Center-Shreveport, Shreveport, LA; Charles S. Kuzma, FirstHealth of the Carolinas, Pinehurst, NC; Michael J. Fisch, AIM Specialty Health, Chicago, IL; Dawn L. Hershman, Columbia University, New York, NY; and James L. Wade III, Heartland National Cancer Institute Community Oncology Research Program, Decatur, IL
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4
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Yoon HH, Foster NR, Meyers JP, Steen PD, Visscher DW, Pillai R, Prow DM, Reynolds CM, Marchello BT, Mowat RB, Mattar BI, Erlichman C, Goetz MP. Gene expression profiling identifies responsive patients with cancer of unknown primary treated with carboplatin, paclitaxel, and everolimus: NCCTG N0871 (alliance). Ann Oncol 2015; 27:339-44. [PMID: 26578722 DOI: 10.1093/annonc/mdv543] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 10/27/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Carboplatin (C) and paclitaxel (P) are standard treatments for carcinoma of unknown primary (CUP). Everolimus, an mTOR inhibitor, exhibits activity in diverse cancer types. We did a phase II trial combining everolimus with CP for CUP. We also evaluated whether a gene expression profiling (GEP) test that predicts tissue of origin (TOO) could identify responsive patients. PATIENTS AND METHODS A tumor biopsy was required for central confirmation of CUP and GEP. Patients with metastatic, untreated CUP received everolimus (30 mg weekly) with P (200 mg/m(2)) and C (area under the curve 6) every 3 weeks. The primary end point was response rate (RR), with 22% needed for success. The GEP test categorized patients into two groups: those having a TOO where CP is versus is not considered standard therapy. RESULTS Of 45 assessable patients, the RR was 36% (95% confidence interval 22% to 51%), which met criteria for success. Grade ≥3 toxicities were predominantly hematologic (80%). Adequate tissue for GEP was available in 38 patients and predicted 10 different TOOs. Patients with a TOO where platinum/taxane is a standard (n = 19) tended to have higher RR (53% versus 26%) and significantly longer PFS (6.4 versus 3.5 months) and OS (17.8 versus 8.3 months, P = 0.005), compared with patients (n = 19) with a TOO where platinum/taxane is not standard. CONCLUSIONS Everolimus combined with CP demonstrated promising antitumor activity and an acceptable side-effect profile. A tumor biomarker identifying TOO may be useful to select CUP patients for specific antitumor regimens. CLINICALTRIALSGOV NCT00936702.
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Affiliation(s)
| | - N R Foster
- Alliance Statistics and Data Center, Mayo Clinic, Rochester
| | - J P Meyers
- Alliance Statistics and Data Center, Mayo Clinic, Rochester
| | - P D Steen
- Department of Medical Oncology, Meritcare Hospital CCOP, Fargo
| | - D W Visscher
- Department of Anatomic Pathology, Mayo Clinic, Rochester
| | - R Pillai
- Pathwork Diagnostics, Redwood City
| | - D M Prow
- Department of Medical Oncology, Iowa Oncology Research Association CCOP, Des Moines
| | - C M Reynolds
- Department of Hematology/Medical Oncology, Michigan Cancer Research Consortium, Ann Arbor
| | - B T Marchello
- Department of Medical Oncology, Montana Cancer Consortium, Billings
| | - R B Mowat
- Department of Medical Oncology/Hematology, Toledo Community Hospital Oncology Program CCOP, Toledo
| | - B I Mattar
- Department of Medical Oncology/Hematology, Wichita Community Clinical Oncology Program, Wichita, USA
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5
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Goetz MP, Foster NR, Meyers JP, Steen PD, Visscher DW, Yoon HH, Pillai R, Prow DM, Reynolds CM, Marchello BT, Mowat RB, Mattar BI, Erlichman C. Use of gene expression profiling to identify responsive patients treated with carboplatin (Carb), paclitaxel (Pac), and everolimus as first-line treatment for cancer of unknown primary (CUP): NCCTG N0871 (Alliance). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.2562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2562 Background: Empiric chemotherapy (taxane/platinum) is standard for CUP. Because prognosis is poor, novel approaches are needed. The PI3K/mTOR pathway is frequently dysregulated in cancer. Everolimus (E), an mTOR inhibitor, is approved for multiple malignancies. We performed a phase II study of Pac + Carb + E as first-line therapy in metastatic CUP patients (pts). We additionally determined if a gene expression profiling (GEP) test that identifies tissue of origin (Pathwork Tissue of Origin) could identify responsive pts. (NCT00936702) Methods: Newly diagnosed, untreated CUP pts were eligible. Central pathology review confirmed CUP prior to registration; GEP was performed on formalin fixed tumor tissue. Pac (200 mg/m2), Carb (AUC=6) and E (30 mg once weekly) were delivered every 3 wks until progression or intolerable adverse events (AEs). The primary endpoint was confirmed response, with ≥11 of 50 responses (22%) needed for trial success. Secondary endpoints were OS, progression-free survival (PFS) and AEs. Results: 46 pts (median age 61) received a median 4 cycles (range: 1-33). 39 (85%), 21 (46%) and 1 (2%) experienced ≥1 grade (gr) 3+, 4+, or 5 (sepsis) AE, with gr 3+ hematologic AE most common (74%). Of 44 evaluable pts, 15 had a confirmed response (RR 34%, 95% CI: 21-50%), with a median PFS and OS of 4.1 and 10.1 mos, respectively. Adequate tissue for GEP was available in 36 pts and predicted 10 different sites of origin. In pts with a predicted tissue of origin in which taxane/platinum is standardly used, higher RR and significantly longer PFS and OS were observed compared with pts whose GEP identified a malignancy where taxane/platinum is not standard (Table). Conclusions: In pts with untreated CUP, Carb +Pac +E demonstrated promising antitumor activity. The GEP test identified patients clinically responsive to Carb/Pac/E therapy, and may be useful to select CUP pts for specific antitumor regimens. Clinical trial information: NCT00936702. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | - Debra M. Prow
- Iowa Oncology Research Association CCOP, Des Moines, IA
| | | | | | - Rex B. Mowat
- Toledo Community Hospital Oncology Program CCOP, Toledo, OH
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6
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Fizazi K, Prow DM, Do KA, Wang X, Finn L, Kim J, Daliani D, Papandreou CN, Tu SM, Millikan RE, Pagliaro LC, Logothetis CJ, Amato RJ. Alternating dose-dense chemotherapy in patients with high volume disseminated non-seminomatous germ cell tumours. Br J Cancer 2002; 86:1555-60. [PMID: 12085204 PMCID: PMC2746595 DOI: 10.1038/sj.bjc.6600272] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2001] [Revised: 02/25/2002] [Accepted: 03/06/2002] [Indexed: 11/09/2022] Open
Abstract
Only about half of patients with a poor-prognosis non-seminomatous germ-cell tumours can achieve a cure. The aim of this phase II study was to assess the efficacy and toxicity of a dose-dense alternating chemotherapy regimen in this subset of patients. High volume non-seminomatous germ-cell tumours was defined as follows: at least two sites of non pulmonary metastases, an extragonadal primary tumour, a serum human chorionic gonadotropin level higher than 10 000 mIU x ml(-1), or a alpha-foetoprotein level higher than 2000 mIU ml(-1). Patients who fulfilled these criteria were treated with the so-called BOP-CISCA-POMB-ACE regimen (bleomycin, vincristine, and cisplatin; cisplatin, cyclophosphamide, and doxorubicin; cisplatin, vincristine, methotrexate, and bleomycin; etoposide, dactinomycin, and cyclophosphamide) plus granulocyte colony-stimulating factor. A total of 58 patients were enrolled. Patients were retrospectively classified according to the International Germ-Cell Cancer Consensus Group classification; 38 patients (66%) had poor-prognosis disease and 19 patients (33%) had intermediate-prognosis. Patients received a median of 2.5 courses (range 0.25 to five courses) of the BOP-CISCA-POMB-ACE regimen. Forty-two patients (72.4%) had a complete response to therapy. With a median follow-up time of 31 months, the 3-year progression-free survival rate was 71% (95% confidence interval, 60 to 84%) and the 3-year overall survival rate was 73% (95% confidence interval: 62 to 86%). The 3-year PFS rates were 83% (95% confidence interval: 68 to 100%) in the intermediate-prognosis group and 65% (95% confidence interval: 51 to 82%) in the poor-prognosis group. Early side effects included mainly grade 4 haematologic toxicity (neutropaenia in 79% of patients, thrombocytopaenia in 69%, anaemia in 22%), grade 4 stomatitis (19%), and four early deaths (7% of patients), at least partially related to toxicity. The dose-dense BOP-CISCA-POMB-ACE regimen is highly active in patients with non-seminomatous germ-cell tumours classified as intermediate-prognosis or poor-prognosis according to the International Germ-Cell Cancer Consensus Group. Because outcomes with this regimen compare favourably with outcome after standard therapy, dose-dense chemotherapy should be further investigated in this subset of patients.
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Affiliation(s)
- K Fizazi
- Department of Genitourinary Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
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7
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Abstract
To develop a more appropriate therapeutic strategy for treatment of nonpulmonary visceral metastatic testicular seminoma based on the International Germ Cell Consensus Classification, we reviewed the medical records of patients with nonpulmonary visceral metastatic testicular seminoma who were treated over a 20-year period. Only 15 (2.2%) of the 686 cases of testicular seminoma were nonpulmonary visceral metastatic seminoma. The median age of patients was 38 years (range, 22-53 years). Ten (67%) of the patients had an initial diagnosis of supradiaphragmatic or visceral metastatic disease. In addition to nonpulmonary visceral metastasis, all patients had lymph node metastasis as well, the majority of which involved the retroperitoneal lymph nodes. The median and mean progression-free survival durations after chemotherapy for advanced disease were 19 months and 63.7 months, respectively. Six patients (40%) survived, five relapsed after radiation therapy and four died of chemorefractory disease not dependent on the specific regimen. Although the number of cases reviewed in this study was small, we conclude that the choice of chemotherapeutic regimen among the current treatments for nonpulmonary visceral metastatic seminoma of testis primary does not present a different outcome. Therefore, multimodality therapies using new strategies or new agents are well indicated.
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Affiliation(s)
- D S Park
- Department of Urology, Pundang CHA Hospital, Pochon CHA University, Sungnam, Korea.
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8
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Abstract
We wanted to present the results of our experience with bilateral testis tumor and to suggest the effects of chemotherapy in suppressing the development of second primary testicular tumors. Between 1978 and 1997, 2,345 patients were treated for testicular tumor at The University of Texas M. D. Anderson Cancer Center. Of these, 2,107 had germ cell cancers. There were 22 (0.94%) cases of bilateral testicular tumor in the overall patient population and 21 (1.0%) cases among patients with germ cell cancer. We reviewed the medical records to determine the incidence of the histological subtype, the incidence of metachronous versus synchronous formation of contralateral tumors, and tumor stage in this patient population. We also examined the effect of chemotherapy in treating the first tumor and preventing the occurrence of a second tumor. Finally, we compared the effect of ultrasonography, serum tumor marker elevation, and physical examination in detecting second tumors. Only one contralateral germ cell tumor developed synchronously; all others developed metachronously. Fifty percent of first tumors were seminomas, compared to 55% of second tumors. The histologic concordance rate for first and second tumors was 35%. Tumor stage was higher among first tumors than second tumors. The majority of second tumors in patients who received chemotherapy for first malignancies tended to be metachronous seminomas. Ultrasonography detected 6 of 21 (28.6%) contralateral tumors before they were evident by physical examination or serum tumor marker elevation. Seminomas were more prevalent among patients with bilateral germ cell disease than patients with unilateral disease. Chemotherapy, when used as treatment for first tumors, may have some effect in preventing the development of nonseminomatous germ cell tumors in the contralateral testicle. Close follow-up of the contralateral testis with ultrasonography is essential for early detection of second tumors. The outcome for patients with bilateral testicular germ cell cancer is excellent, secondary to early detection.
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Affiliation(s)
- D S Park
- Department of Urology, Pundang CHA Hospital, Pochon CHA University, Sungnam, Korea.
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9
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Prow DM. Germ cell tumors: staging, prognosis, and outcome. Urol Oncol 1998; 16:82-93. [PMID: 9649231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Germ cell tumors (GCT) remain the model for solid tumor therapy. Until 1997, GCT staging was based on individual institution systems, which limited comparison of data and collaboration between GCT groups. GCT staging is based on four basic criteria: disease site of origin, histology, secretion of serum tumor markers (STM), and bulk of disease. Within most staging systems developed by investigators, clinical stage I disease is confined to the testis based on radiographic imaging and STM or pathological stage I based on lack of histological disease at retroperitoneal lymphadenectomy. Stages II and III are considered to be disease outside the testis categorized by lymphatic spread to the retroperitoneal lymph nodes or hematological spread to lungs and visceral organs, respectively. The major staging systems previously used include the Indiana University Staging System; Modified Samuels' Classification (M.D. Anderson Cancer Center); Memorial Sloan Kettering Cancer Center Mathematical Model; and the Tumor, Nodal, Metastases (TNM) Staging System (American Joint Committee on Cancer). The most recent evolution in staging systems is the 1997 International Germ Cell Consensus Classification, which is based on prognosis and outcomes. This system allows for comparison of data and collaboration between Germ Cell Tumor Groups.
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Affiliation(s)
- D M Prow
- Department of Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA
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10
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Abstract
Platelet activating factor (PAF) is a phospholipid mediator of inflammation and vascular leakage that may be important in the etiology of asthma. We and others have demonstrated that PAF causes vascular leakage in the rat trachea. In the present study, we attempted to determine how PAF mediates this effect. Vascular leakage was quantitated by measuring the amount of intravascular Evans blue dye extravasated into tracheal tissue. Intravenously administered PAF increased vascular leakage, although Lyso-PAF and Enantio-PAF had no effect. PAF-induced vascular leakage was inhibited in a dose-dependent fashion by the PAF receptor blocker WEB 2086. However, PAF-induced vascular leakage was not inhibited by blockade of cyclooxygenase/lipoxygenase, calmodulin, calcium channels, protein kinase C, histamine receptors, or by destruction of peptidergic sensory nerves. We conclude that PAF causes vascular leakage in the rat trachea by a stereospecific receptor-mediated mechanism that does not depend on arachidonic acid metabolites, calcium, protein kinase C, histamine, or peptidergic sensory nerves.
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Affiliation(s)
- C M Kirsch
- Division of Respiratory Medicine, Santa Clara Valley Medical Center, San Jose, California 95128
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11
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Brokaw JJ, Prow DM, Kirsch CM, White GW. Effects of platelet-activating factor on vascular permeability and granulocyte recruitment in the rat trachea. Lung 1991; 169:109-19. [PMID: 1648156 DOI: 10.1007/bf02714148] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Platelet-activating factor (PAF) is a phospholipid mediator known to produce several features of airway inflammation. We examined the effects of intravenous PAF on vascular permeability and granulocyte recruitment in the rat trachea. To assess vascular permeability, anesthetized rats were given injections of Evans blue dye (30 mg/kg, iv) and PAF (1-10 micrograms/kg, iv), and then their tracheas were removed and assayed spectrophotometrically for dye content. We found that a PAF dosage of 6 micrograms/kg increased the tracheal dye content 7-fold compared to controls. The amount of extravasated dye in the tracheas was significantly increased 1 min after PAF injection, was maximal at 5 min, and had returned to control levels by 10 min. To assess granulocyte recruitment, anesthetized rats were given an injection of PAF (6 micrograms/kg, iv), and then their tracheas were removed and stained to reveal myeloperoxidase-containing neutrophils and eosinophils. We found that the number of neutrophils in the tracheal mucosa was increased 7-fold from controls 5 min after PAF injection, but was not significantly increased 6 h later. The number of eosinophils in the tracheal mucosa was not significantly increased from controls at any time after PAF injection. We conclude that intravenous PAF causes a rapid but transient increase in vascular permeability in the rat trachea, and that intravenous PAF also causes a rapid but transient recruitment of neutrophils into the tracheal mucosa without a similar effect on eosinophils.
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Affiliation(s)
- J J Brokaw
- Department of Anatomy, Indiana University School of Medicine, Evansville 47732
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